Janet Ruth Medenwald Hogg, M.D.
Individual provider Active NPI Psychiatry Physician · San Bernardino, CA
NPI 1770664286 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1770664286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- G58422 (CA)
- Practice address
- Step Up on Second; 600 N. Arrowhead Ave, Suite 200
San Bernardino, CA 92401-1152 - Phone
- (909) 963-5355
- Fax
- (909) 453-3205
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58422 | CA | MD | Pharmacist |
| G58422 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Puentes Al Sur | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G58422 | CA | Yes |
Addresses
Primary practice location
Step Up on Second; 600 N. Arrowhead Ave, Suite 200
San Bernardino, CA 92401-1152
Mailing address
18555 Avenida Escalera
Murrieta, CA 92562-8611
Phone (831) 346-8236
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G58422 | Other | CA | MEDICAL LICENSE # |
| ZZZ91891Z | Other | CA | MEDICARE GROUP ID# |
| ZZZ91892Z | Other | CA | MEDICARE GROUP ID# |
| ZZZ92069Z | Other | CA | MEDICARE GROUP ID# |
| BP973 | Medicaid | CA | |
| 00G584220 | Medicaid | CA |
Other names
- Janet Ruth Medenwald
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All providers in San Bernardino, CA · Psychiatry Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.